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I’m going to do something a little different this week and write something a bit more personal this week, something a bit more, well, extemporaneous. I’ve been working on being sick for the last couple of weeks and of course the day it comes to a head is the day I have an article that needs writing. So, I’m going to aim for a little less polish and a little more from the hip this time, and my apologies if it’s not the most pristine bit of prose you’ve ever read because, well, I’m a bit under the weather. It’s likely to be more questions than answers today, but for some reason I felt that rather than pontificating I needed to show the other side a bit. Here we go.
A collection of thoughts about being in practice.
1. It’s hard being a natural medicine practitioner when you’re relatively sickly. I’m a fairly good sized guy.When I was
born my mom’s OB/GYN declared I was going to play for the Tampa Bay Buccaneers when I grew up. (This was not a curse, I’m from Tampa.) You don’t really think “poor health, very deficient” when you look at me. However, I’m kinda sickly and I’ve kind of been that way my whole life, for reasons multifarious. I feel like I’ve come a long way in the last few years, but I still tend to be on the weak side, not able to do all that much in the way of physical activity, coming down with things a lot, etc. (When I moved in January, afterward I was sick until sometime mid March). The point here is that I frequently find myself (like today, for instance) in the middle of a diagnosis with a patient thinking “How exactly is this person supposed to believe in my ability to improve their health when, despite my best efforts, my own personal health is so poor?”
2. Treating chronic disease is an exercise in patience and frustration management. Chronic disease is what I look for, my preferred type of case. The really difficult, chronic, life-crippling stuff. This is because these are the patients I most want to help, whose lives would be the most changed by a positive result. Despite having the tools at my disposal to do just that and making observable progress, it’s still a very frustrating process. Sometimes these things really do take four or five years to pull off, and that with hitting a home run every week. Patients get frustrated and drop out, really committed patients have other disasters befall them or are being crippled by their Western treatment regimens, patients that are doing absolutely everything right still continue to suffer greatly in the process of improvement. Some days it’s hair-pulling. Some days it’s heart breaking. This is part of the acupuncturists life that they seemed to have missed in school.
3. Doing things in the right order takes a lot of faith and self-confidence. I have multiple patients who have some sort of chronic pain who, to my mind, are great examples of the Neijing maxim that “all pain, sores, and itching come from the Heart.” They have chronic pain that
is being directly or indirectly caused by upper jiao blockage due to emotional distress followed by a walling off of the psycho-emotional energies of the Heart and Lungs. In both cases a powerful resistance to dealing with the loss of loved ones is crippling circulation and leading to a variety of additional symptoms, like dysmenorrhea. However, it’s not the easiest thing in the world to be charging a pretty good sized sum of money to someone who has come to you for elbow pain which isn’t really getting better and having to tell them “look, we gotta keep focusing on that emotional blockage first in order to get to your pain, otherwise we’re just knocking our heads against the wall.” Is it the truth? Absolutely. Do I still kinda worry that it’s going to make me and every other acupuncturist alive look bad and one day she’ll stop coming in and tell her friends about what a waste it was and…you bet. After all, you can’t have a good neurosis without a lot of work.
4. Some days you feel like you did everything wrong, and yet everything right happens. I’ll never understand this one. You needled these two points and…just didn’t “feel it.” Like there was no real connection. You had to more or less guess on the formula and just kinda threw it out there, not really knowing what would happen. You were too beat to take a proper pulse and so had to work out what to do from other angles, and even then things didn’t seem right. You were sure that what you did was going to fail utterly. However, the next time you talk to the patient, they’re thrilled with the results. Go figure.
5. Some days you feel like you did everything right and the case barely budges. See #2
6. You really do have to get used to the idea that patients are frequently so closed off, out of touch with themselves/reality, and self-unaware that they have no idea what’s really wrong with them. Frequently they can’t even tell you if things are better or worse because they literally have no idea. See #3
7. The practices of other practitioners is going to make you really mad some days. You’re going to hear about people who are essentially running a health food store/supplement supply under the guise of a medical license for all the hawking of goods they do. They will practice lousy medicine, though their patients probably don’t realize it. They will have evolved into the Monte Hall model by force of necessity, because their actual CM acumen is so poor. So in order to survive, they will pull in every modality, every product, everything in existence into their practice and sell it all. Their practice will be bigger than yours, they will be making more money than you, their car/address will be nicer, they will be in the local magazines. They will still not know what they are doing, they will not be reaching the level of results our ancestors expect from us, however they will be feeding the consumer culture of our society, and that is why they will be doing well. You will know this, but it will still make you mad.
8. Your practice is going to make you really mad some days. You will find yourself saying “if this stuff is so great, if I’m practicing such a superior modality, if my herbs are such high quality, if I have it on absolute fact that I am doing what my patient needs when they need it, then why in the hell aren’t any of them completely cured? If my way is better, then why is it such a small operation? If I’m so great then why do I ride the bus instead of my Mercedes/Porsche/whatever? Why aren’t I better at treating emergency/acute/chronic/mystery/women’s/men’s/children’s/animals illnesses? Why do I have so few answers?” Again, neurosis takes work.
9. All of these things will come and go along with this thought: man, this stuff is really great and I feel good. Yin transforms into Yang and Yang transforms into Yin. Good days, bad days, they’re all part of it it seems. I personally think that people who only have good days (residents of Portland notwithstanding) need psychological evaluation and a lie detector test. Just try to remember that when things are bad that soon it will turn around and that when things are good that you don’t have all the answers just yet.
Tags: Chinese medicine, Acupuncture
{ 9 comments… read them below or add one }
Just because I like to be contrary, let me ask you this question. If you weren’t sort of sickly (despite being a healthy looking guy) would you have the patience and interest to treat those chronic people? Would you have the patience and understanding of their frustrations of doing everything “right” and still not getting the results that they’d like? Just a thought.
I honestly have no idea. That’s like asking “What if the USA didn’t exist and instead there were Dutch, English, and Mormon nations taking up most of North America?” which would then of course be an L. E. Modesitt book series. :D
Seriously, I think this falls under Divine Providence/happens for a reason.
Tough situation.
Honestly, it’s a difficult medicine, and good philosophy isn’t always (or perhaps even often) enough. There’s a certain meat of experience that fills and transforms the same ideas you know into ideas you really understand.
In China, though the state of education in school is poor, good doctors continue their real education with teachers well after graduation. Residencies can stretch years, even decades. It takes different forms, some doctors work under their seniors in hospitals, some with their teacher in the same clinic. Of course American schools have clinic rounds, though from what I hear, they are too short and often with many different teachers. Nice to get a taste of different styles, but if that’s all you get, just appetizers then out the door, well…
It takes time to learn a style, even more time to develop your own. Theory plus practice equals wisdom and good teachers are catalysts. Though it’s a synthesis never really ends, there are discrete stages. Without a residency system, I fear many may spend a lifetime without getting over the first hurdle. Stages, wisdom, understanding – it’s all vertical. Cultivators unable to build up high enough, or dig down deep enough, reach out horizontally.
Get mad, the horizontal sprawl mentality is gas for the fire of our yin deficient day-and-age.
Well the difficulty with a residency system is the same as in China, that the current primary model of Chinese medicine is TCM and further reinforcing that particular travesty is going to harm and not help. Learning a flawed system to the point of reflex is only going to produce flawed reflexes.
Now, if there were a couple inpatient facilities practicing one of the genuinely effective forms of CM (CCM being my preference of course) then we’d be in business. But that may be a ways off yet.
You may be surprised at the variety found in Chinese practices. Good doctors invariably study the classics and/or have trained in a medical lineage. Good doctors also invariably attract students who want to intern with them after graduation.
Even within the universities you can find good clinicians – unfortunately when you do, they still aren’t allowed to teach ‘off the book’. So formal education is a bland, dead, flawed system. However, talk to them after class about their real interests, and you’ll find a different medicine. Because the residency is informal, you don’t learn “TCM” with your teacher, you learn their art of medicine.
I don’t see what makes this hard to do in America. Find an experienced doctor you respect, who practices the medicine how you’d like to practice, and work along side them (not across town, but side by side, every day) for a number of years. If they’re good, they probably have more patients than they can handle anyway. Do we need to wait for it to become institutionalized?
Good food for thought…
here are my thoughts about a couple points that struck me more:
#1 – I too had my share of health challenges and I find it helpful when relating to patients. I looked at my health issues and dug deep. This exercise helped me see deeper in my patients and their pathologies.
#3 – now, the treatment of pain (be it acute of chronic) is my favourite topic. In my (brief) experience, what is taught in acupuncture schools regarding the treatment of pain is not very effective. I use the more modern concept of trigger points (which is related to, but different from Ashi points). Using modern medical science discoveries along with ancient meridian theories is the way to go if we want to be effective. I’ve treated chronic pain that was resistant to medication, osteopathy, chiro and physio for several years, in one or 2 treatments (and I’m talking 95% to 100% success that lasted). I believe that it is essential to study the Classics and keep them in mind, but we also have to learn from what is good in modern bio-medicine. This is what I saw in China, and they come up with new techniques that are impressively effective.
Patrick, you are right! I was in China in 2005 and when I went back in 2010, I met an old friend still apparently in the same position, following the same doctor… my first thought was to consider it a failure to still be in the same subordinate position after 5 years. But what you say is right. He’s probably becoming a great doctor.
With respect, it’s pretty easy to put just about anything up against the Chinese medicine taught/practiced in the US via the TCM model and see it as more effective. However, considering how few people on Earth are really practicing honest-to-goodness Classical acupuncture (I only know a couple) it’s unlikely that most are in a position to make any kind of value judgment regarding the efficacy of the Classical way, only because they’ve never actually come into contact with it.
To be a little more direct, it’s fine and well to say that the Classics have their place and need to be combined with modern “discoveries”. However, this forces me as an advocate of the Classical approach to ask “Ok, so have you learned de facto Classical acupuncture? What were your results? Where did it succeed? Where did you have trouble? How long did you study it? Whom did you learn from? How long did you use it?”
No 0ffense intended Stéphane, but I’ve yet to meet someone who had actually learned Classical acupuncture (rather than stating an off-the-cuff opinion) who then felt they needed to augment it with something else because of a lack of efficacy.
The best person I could possibly direct you to (because I am NOT trained in Classical acupuncture and only have a tiny amount of it under my belt, much to my shame) is Edward Neal. Have a look at his site here: http://www.neijingacupuncture.com/
Regarding the treatment of pain I would definitely have to agree with Michael. I had been treated for a rather vexing, sometimes debilitating pain condition of the lower back using a variety of acupuncture methods including some of the more modern trigger point therapies. I have to admit that, among the methods I had used, the most innovative TCM+biomedicine seemed to have the most dramatically positive results.
Then I saw an intern of Ed Neal’s at NCNM. Ed collaborated closely with her in treatment. I was pain free within 3 sessions. The pain has never returned. That’s simply one, personal, example of the excellent results I have seen in person and heard about second-hand when a deeply Classical approach is used.
Eric
I’ve set up a spot on the forum for continuing this discussion as clearly it’s something that needs continuing dialog. You can find it here: http://deepesthealth.com/forum/viewtopic.php?f=4&t=55